Peripheral Vascular Function in Dilated Cardiomyopathy of Different Etiology

Vascular function in dilated cardiomyopathy of different etiology has been poorly investigated. Moreover, reference values of flow-mediated dilation (FMD) in chronic heart failure (CHF) need to be updated according to the new standardized protocols. We characterized the vascular impairment in different stages of post-ischemic dilated cardiomyopathy (PI-DC) or idiopathic dilated cardiomyopathy (I-DC). Eighty consecutive outpatients with CHF in different New York Heart Association (NYHA) classes (45 PI-DC, 35 I-DC) and 50 control subjects underwent FMD and brachial distensibility coefficient measurement. Patients with CHF showed a marked impairment in FMD compared with controls that worsened from classes NYHA I-II to III-IV, independently of etiology (P <.05). New York Heart Association I-II PI-DC patients showed a worse FMD compared with NYHA I-II I-DC patients (P <.05). Brachial distensibility coefficient values were significantly lower in patients with CHF compared with controls (P <.001) without differences between PI-DC and I-DC. In conclusion, advanced CHF is characterized by vascular impairment that is independent of etiology. In the early stages of CHF, endothelial dysfunction is more severe in patients with PI-DC compared with I-DC probably due to the high cardiovascular risk profile. In I-DC, vascular function impairment is independent of cardiovascular risk factors and could participate in the pathogenesis of I-DC

Effects of long-term L-thyroxine treatment on endothelial function and arterial distensibility in young adults with congenital hypothyroidism.

OBJECTIVE: Patients with congenital hypothyroidism (CH) display subclinical abnormalities of the cardiovascular system that are related to unphysiological fluctuations of TSH levels and occur despite careful replacement therapy. DESIGN: The aim of the present case-control study was to evaluate the effects of long-term levothyroxine (l-T(4)) replacement therapy on the vascular district in CH patients by assessing endothelial function with flow-mediated dilation (FMD) and brachial artery distensibility with the measurement of the coefficient of distensibility (DC). METHODS: Thirty-two young adults with CH aged 18.9+/-0.2 years and 32 age- and sex-matched controls underwent brachial Doppler ultrasound examination to measure FMD and DC at the time of the study. Hypothyroidism was diagnosed by neonatal screening, and l-T(4) treatment was initiated within the first month of life. RESULTS: Compared to healthy controls, CH patients had significantly reduced brachial artery reactivity with lower FMD values (8.9+/-5.7 vs 14.1+/-5.1% P=0.003) and decreased vascular distensibility (24.6+/-1.6 vs 27.3+/-3 kPa(-1)x10(-3), P<0.0002). Linear regression analysis revealed that both total and pubertal mean TSH and number of episodes of undertreatment were independent determinants of FMD and DC. Pubertal mean TSH was the best predictor of both FMD and DC (r=0.81 and r=0.87 respectively, P<0.001). CONCLUSIONS: Young adults with CH treated with long-term l-T(4) replacement therapy may have significant impairment of both FMD and DC. Our data suggest that high TSH levels, inadequately corrected by l-T(4) replacement therapy in CH patients especially during puberty, can exert significant effects on the elastic and functional vessel properties

Endothelial function of conduit arteries in patients with ulcerative colitis and metabolic syndrome.

Although ulcerative colitis (UC) is characterized by chronic inflammation and elevated circulating plasma levels of C reactive protein and TNF-alpha, well recognized cardiovascular risk factors, several studies have suggested that patients with UC do not bear an increased risk for cardiovascular diseases. However, recent reports have shown that UC is associated with increased intima-media thickness and impaired endothelial function. On the other hand, endothelial dysfunction is strictly related to premature atherosclerosis and cardiovascular diseases in different populations. In addition, metabolic syndrome (MS) is associated with impairment of endothelial function in the general population, while the impact of MS on endothelial function in UC patients is unknown. Aim of this study was firstly to clarify, in a large group of patients, whether endothelial function of conduit arteries is affected by UC. Secondly, to investigate whether MS in patients with UC has an impact on the endothelial function. Among the patients with UC, twenty-three were also affected by MS, whereas twenty-two patients with MS were present in the control group. FMD was similar in patients with UC and controls (11.8±0.9% and 12.2±0.8, respectively, p=NS). While the presence of MS in the control group was associated with impairment of endothelial function (13.6±0.8% in healthy controls and 10.2±0.6 in patients with MS, p=0.003), patients with MS and UC did not show any worsening of their endothelial function (11.4±1.0% in patients with UC and SM and 12.1±1.3 in patients with UC without MS; p=0.35). NMD was similar in all the groups

Management of chronic heart failure: Role of home echocardiography in monitoring care programs

AIM: To identify a possible role of home echocardiography for monitoring chronic heart failure (CHF) patients

Human immunodeficiency virus per se exerts atherogenic effects.

Objective: Premature atherosclerosis in HIV-infected patients has been attributed to highly active antiretroviral therapy (HAART) and the associated metabolic complications. Whether HIV per se plays a role is an unresolved issue. The purpose of this study was to evaluate whether HIV per se exerts atherogenic effects.Methods: We measured carotid intima-media thickness (IMT) and brachial endothelial-dependent (FMD) and endothelial-independent (NMD) vasodilation in 38 naive untreated HIV-infected patients and 41 healthy control subjects.Results: Control subjects were selected as to match the HIV patients for metabolic risk factors. Mean carotid IMT was higher in HIV patients (0.85 +/- 0.2 mm; p < 0.001) than in controls (0.63 +/- 0.1 mm). In a stepwise multiple regression model, the changes in carotid IMT were predicted by the duration of HIV infection (p < 0.001)and CD4T-cells (p = 0.035). Brachial FMD was impaired in HIV patients (8.8 +/- 3% versus 12.2 +/- 3% in controls; p < 0.001). In contrast, NMD values practically overlapped in the HIV patients and controls. Analysis of the data in relation to viral load showed that FMD was significantly more impaired in the subgroup of patients with viral load values above the median (p < 0.001). In addition, there was a highly significant, inverse correlation between FMD and the HIV-RNA copies (p < 0.001).Conclusion: HIV infection causes functional and structural vascular alterations in a very early stage of the infection independent of HAART and metabolic factors. The data lend support to the viral infectious theory of atherosclerosis. Early assessment of the vascular status in HIV-infected patients is suggested

Impaired diastolic function in naïve untreated human immunodeficiency virus infected patients

AIM: To evaluate cardiac function and structure in untreated human immunodeficiency virus (HIV) patients without clinical evidence of cardiovascular disease